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FITM Extended Interview: XRS Medical (Marie-Isabelle Batthyány) · AHF Podcast

• 0:26
  Marie-Isabelle Batthyány: My name is Marie-Isabelle Batthyány.
• 0:28
  Marie-Isabelle Batthyány: I'm an board certified anesthesiologist specializing in orthopedic anesthesia at the orthopedic hospital.
• 0:36
  Marie-Isabelle Batthyány: Surprising in Vienna.
• 0:38
  Marie-Isabelle Batthyány: And I'm also the founder and CEO of XRSynergies, uh, which is an Austrian company where we build vr, virtual reality patient education tools designed for maximum legal, security and efficiency for our fellow doctor colleagues.
• 0:57
  Joseph M. Schwab: So Marie, thank you for joining me today.
• 1:00
  Joseph M. Schwab: I what I wanna ask, first of all.
• 1:02
  Joseph M. Schwab: Is you saw some sort of gap in informed consent with patients and in patient education.
• 1:10
  Joseph M. Schwab: Was there a personal or clinical moment that kind of first made you aware of these gaps?
• 1:16
  Joseph M. Schwab: How did it start?
• 1:19
  Marie-Isabelle Batthyány: Mm.
• 1:20
  Marie-Isabelle Batthyány: I guess by spending endless days in pre-clinicals already during my early training and just trying to get some information on impending surgery through to the general patient population, so which actually means weary patients with lots of questions I couldn't really answer proper.
• 1:39
  Marie-Isabelle Batthyány: Back then anyway as a junior.
• 1:42
  Marie-Isabelle Batthyány: So medicine since then has evolved with so much innovation.
• 1:47
  Marie-Isabelle Batthyány: I mean, look around you, orthopedics is, uh, really leading in this field, but somehow the whole informed consent situation just didn't evolve.
• 1:59
  Marie-Isabelle Batthyány: I worked all over the world, including South Korea and countries like Belgium and the uk.
• 2:05
  Marie-Isabelle Batthyány: But it's just really the same everywhere.
• 2:08
  Marie-Isabelle Batthyány: And any doc you spoke to shouted you that endless lamentation when having to do the consent talk.
• 2:15
  Marie-Isabelle Batthyány: I hear a rumor that most docs who can afford it don't do the consenting themselves at all because they really don't find the time and, and have the the patience and will to do it.
• 2:26
  Marie-Isabelle Batthyány: So we had to use paper forms, um, uh, as, as I nowadays see as one of those gaps.
• 2:33
  Marie-Isabelle Batthyány: Uh, we had to use paper forms, which is still the most commonly used medium in consenting today, but actually no one ever reads them.
• 2:42
  Marie-Isabelle Batthyány: So you find yourself explaining the same all day all over again, knowing deep down that your patient only understood half of what you were saying.
• 2:52
  Marie-Isabelle Batthyány: Chances you would be in trouble if you didn't do it properly where and are fairly high.
• 2:59
  Joseph M. Schwab: You mentioned a few gaps there, and I wanna know what was the most pressing problem of those that you identified?
• 3:06
  Joseph M. Schwab: Was it the time pressure, uh, the pressure of the surgeons?
• 3:09
  Joseph M. Schwab: Was it the lack of standardization or the medium used?
• 3:13
  Joseph M. Schwab: Was it the patient understanding or was it the legal vulnerability?
• 3:20
  Marie-Isabelle Batthyány: I mean, we've all been there.
• 3:22
  Marie-Isabelle Batthyány: I will be 48 next week, and I collected so many issues in patient communication and actually medical communication during my medical career.
• 3:33
  Marie-Isabelle Batthyány: But what stuck with me was the situation really early on in my anesthesia training.
• 3:39
  Marie-Isabelle Batthyány: I was still a resident back then.
• 3:42
  Marie-Isabelle Batthyány: A lady who was scheduled, she was around 60 for very extensive gastric surgery, and I visited her in her room at the hospital the day before to tell her what we would be doing to her during anesthesia.
• 3:56
  Marie-Isabelle Batthyány: And she was sitting there, all her documents were already signed, and when I got to the part of telling her that she would need a gastric tube after her surgery, she looked at me and she said, why would I need that?
• 4:09
  Marie-Isabelle Batthyány: And I told her, because you won't have a stomach lift after surgery.
• 4:14
  Marie-Isabelle Batthyány: And she was so utterly shocked because she was still wasn't aware that of the fact that she was going to spend the rest of her life being fed through a tube.
• 4:25
  Marie-Isabelle Batthyány: And that was the, the initial situation where, where I thought.
• 4:31
  Marie-Isabelle Batthyány: That the issues in patient communication are so evident in practice and in literature that I'm still amazed how little has changed since the Helsinki declaration in 64.
• 4:43
  Marie-Isabelle Batthyány: Um, and I wrote my MBA thesis on the topic of eligibility of virtual reality in patient education and informed consent.
• 4:52
  Marie-Isabelle Batthyány: And that's where I found my scientific confirmation that the whole consent sector really is in trouble.
• 4:59
  Joseph M. Schwab: Yeah.
• 4:59
  Marie-Isabelle Batthyány: So.
• 5:01
  Marie-Isabelle Batthyány: I think when you ask me about which problem is most prominent, I have to answer pretty much all of them.
• 5:07
  Marie-Isabelle Batthyány: But for me personally, the strongest is legal and anesthesiologists are not the greatest talkers.
• 5:14
  Marie-Isabelle Batthyány: According to many videos on YouTube, we prefer Sodoku in the chair to rest of weary heads on.
• 5:21
  Marie-Isabelle Batthyány: Uh, but on a serious note, uh, whenever I check out the program at a conference and I want to attend, uh, the lecture about the legal implications of improper informed consent, I can get a, can't get a seat because the room is so packed.
• 5:36
  Marie-Isabelle Batthyány: So docs aren't worried about legal implications and we all work so hard.
• 5:42
  Marie-Isabelle Batthyány: And what do we want?
• 5:44
  Marie-Isabelle Batthyány: We don't want to think about possible lawsuits or unhappy patients.
• 5:49
  Joseph M. Schwab: And so what was it about either that story or the way you thought about it afterwards?
• 5:55
  Joseph M. Schwab: That took you from thinking somebody needs to fix this problem to Maybe that's somebody is me.
• 6:03
  Marie-Isabelle Batthyány: Mm-hmm.
• 6:05
  Marie-Isabelle Batthyány: Um.
• 6:06
  Marie-Isabelle Batthyány: It, that situation with, uh, this, uh, lady patient, it, it came back, um, many times to me.
• 6:15
  Marie-Isabelle Batthyány: And, uh, it resulted in the end, uh, during my MBA, which I did in 2018, I came to a point where I had talked to so many different people from different fields, um, providing me with information what else is out there in the world.
• 6:34
  Marie-Isabelle Batthyány: And, um.
• 6:35
  Marie-Isabelle Batthyány: Actually taking a first peak into, into the tech world.
• 6:40
  Marie-Isabelle Batthyány: So I, um.
• 6:42
  Marie-Isabelle Batthyány: I thought, how could I combine this?
• 6:44
  Marie-Isabelle Batthyány: Um, with solving problems we are facing every day in our clinical lives.
• 6:50
  Marie-Isabelle Batthyány: And I actually did think, yes, this could be me because there was no one else around doing it.
• 6:57
  Marie-Isabelle Batthyány: We are up to this day, uh, with our solution pretty much singled out.
• 7:03
  Marie-Isabelle Batthyány: Um, and, and rather unique, uh, because it's such a neglected field and.
• 7:12
  Marie-Isabelle Batthyány: This is also based on, on, on the clinical experience.
• 7:17
  Marie-Isabelle Batthyány: The biggest misconception lies in, in neglect of informed consent.
• 7:22
  Marie-Isabelle Batthyány: I.
• 7:24
  Joseph M. Schwab: So from your perspective in your clinical experience is neglect, uh, of the patient education and informed consent, what most healthcare systems get wrong or is it something else?
• 7:38
  Marie-Isabelle Batthyány: Mm.
• 7:39
  Marie-Isabelle Batthyány: I do think neglect is one of the main issues because nobody really pays attention.
• 7:45
  Marie-Isabelle Batthyány: Informed consent is, is not a niche in truth.
• 7:48
  Marie-Isabelle Batthyány: It's huge.
• 7:50
  Marie-Isabelle Batthyány: There's so much money, time, and responsibility involved when things go sideways in consent, uh, which makes it clear.
• 7:58
  Marie-Isabelle Batthyány: Uh.
• 7:59
  Marie-Isabelle Batthyány: That is just not a niche.
• 8:01
  Marie-Isabelle Batthyány: Uh, not for hospital management, not for pharma, not for private clinics.
• 8:06
  Marie-Isabelle Batthyány: And, uh, numbers are rising in litigation cases.
• 8:12
  Marie-Isabelle Batthyány: They range from$800,000 upwards, but to most of us doctors, it is a niche nobody really wants to think about much so.
• 8:25
  Marie-Isabelle Batthyány: Somehow we are always on the legally questionable side.
• 8:27
  Marie-Isabelle Batthyány: No matter how diligently we document, we usually don't have time.
• 8:33
  Marie-Isabelle Batthyány: Um, healthcare systems get that wrong, that we actually have the time to speak to patients, but in truth we don't and or somebody else does it for us.
• 8:45
  Marie-Isabelle Batthyány: There's no control of which patient sees or hears what.
• 8:49
  Marie-Isabelle Batthyány: There's no quality, quality management or standardization behind and.
• 8:54
  Marie-Isabelle Batthyány: There's always these questions we, we have to ask ourselves.
• 8:59
  Marie-Isabelle Batthyány: I think, um, do, do our patients even remotely understand what we will, um, what we will be doing to them and how they can actively participate in improving their outcome.
• 9:15
  Marie-Isabelle Batthyány: So.
• 9:17
  Marie-Isabelle Batthyány: It, it, it, it again reflects on our surgeons and, and physicians, um, that many patients report negative experience with medical education,
• 9:28
  Joseph M. Schwab: So why do traditional materials, paper and traditional videos, why do they fail to achieve comprehension in patients?
• 9:37
  Joseph M. Schwab: Hmm.
• 9:39
  Marie-Isabelle Batthyány: but the main medium is still paper forms.
• 9:42
  Marie-Isabelle Batthyány: So, uh, which are not read.
• 9:45
  Marie-Isabelle Batthyány: I think that answers the question in very short, but currently we do live in times with very short attention spans.
• 9:54
  Marie-Isabelle Batthyány: So if you take a ten second video and some, and you get somebody to watch this video for 10 seconds, you're already doing great.
• 10:03
  Marie-Isabelle Batthyány: So people are used to fast content, have difficulties in concentration, and they're young and they're old.
• 10:10
  Marie-Isabelle Batthyány: Same thing.
• 10:11
  Marie-Isabelle Batthyány: So when you make a decision about having surgery, the fear and uncertainty add to even less concentration.
• 10:20
  Marie-Isabelle Batthyány: So when you present patients with a paper form in bold point size nine and seven pages long, they just won't read it.
• 10:28
  Marie-Isabelle Batthyány: And if you ask someone to watch a video, they're easily distracted.
• 10:33
  Marie-Isabelle Batthyány: So now paying attention to what expect from surgery can influence outcome, compliance satisfaction with a procedure.
• 10:40
  Marie-Isabelle Batthyány: We, we know this and we have so much evidence.
• 10:45
  Marie-Isabelle Batthyány: That, uh, it just doesn't work.
• 10:48
  Marie-Isabelle Batthyány: Uh, the material we give to patients, it doesn't reach them anymore.
• 10:53
  Joseph M. Schwab: So XRS medical tries to, uh, handle this situation with a virtual reality workflow.
• 11:03
  Joseph M. Schwab: I want you to walk me through what exactly happens from the moment a patient puts on this headset to the moment the report is generated.
• 11:14
  Marie-Isabelle Batthyány: I think, uh, let's use, um, uh, a practical example for this, if I may, uh, use you for this.
• 11:22
  Marie-Isabelle Batthyány: Joe.
• 11:22
  Marie-Isabelle Batthyány: Uh, imagine this, you're scheduled for hip replacement on a busy clinic day, so there's much going on around you.
• 11:30
  Joseph M. Schwab: I hope it's an anterior approach, hip replacement.
• 11:34
  Joseph M. Schwab: Okay.
• 11:34
  Marie-Isabelle Batthyány: of
• 11:35
  Joseph M. Schwab: Whew.
• 11:36
  Joseph M. Schwab: Good.
• 11:37
  Marie-Isabelle Batthyány: there is so much going on around you, and a nurse walks up to you and puts a light headset on your head.
• 11:44
  Marie-Isabelle Batthyány: She adjust a headset band in the back and makes sure you sit comfortably.
• 11:49
  Marie-Isabelle Batthyány: And the video starts automatically as you, as soon as, uh, the headset cameras recognize the viewer, so the patient, you has to do nothing about it.
• 11:59
  Marie-Isabelle Batthyány: Everything is automatized and kept simple.
• 12:03
  Marie-Isabelle Batthyány: You are transported into a calm, very pretty room and where, and now it gets weird.
• 12:10
  Marie-Isabelle Batthyány: I'm sorry.
• 12:12
  Marie-Isabelle Batthyány: The orthopedic surgeon explains to you in your mother tongue, which by now I'm sure is fluent Swiss German.
• 12:21
  Marie-Isabelle Batthyány: And in any case, uh, easy to understand terminology.
• 12:26
  Marie-Isabelle Batthyány: How to the procedure works, what the risks are and what to expect from surgery.
• 12:31
  Marie-Isabelle Batthyány: So the more complicated parts are visualized in very simple animations without, as we say in German, um, you have forgotten the puzzling sound around you, and you focus on what you digital twin is actually saying.
• 12:45
  Marie-Isabelle Batthyány: So when the info experience is finished, you're asked to take the headset off and return it to admin where you got it from.
• 12:54
  Marie-Isabelle Batthyány: And during your viewing the eye tracking data.
• 12:58
  Marie-Isabelle Batthyány: Which is an algorithm we, uh, developed, uh, within our company, um, is to to track attention that I hope you paid to your digital twin, uh, is then computed by our software into a yes.
• 13:14
  Marie-Isabelle Batthyány: Joe was attentive, no, Joe was not attentive and in real time.
• 13:20
  Marie-Isabelle Batthyány: Actually only takes a few seconds.
• 13:22
  Marie-Isabelle Batthyány: It's available in our web platform for, um, download.
• 13:26
  Marie-Isabelle Batthyány: And this comes in an attention evaluation report, which is customizable to any legal system, so country independent, um, and, uh, accessible on the web platform.
• 13:40
  Marie-Isabelle Batthyány: And you can, the admin staff can hand it to the doctor so you can discuss your remaining questions.
• 13:46
  Marie-Isabelle Batthyány: Or with the study nurse, depending on, on the system we're in.
• 13:52
  Marie-Isabelle Batthyány: So, um, your, your, your digital twin Actually, what, what, uh, our colleagues appreciate most about those videos is that it can be them talking to the patients.
• 14:05
  Marie-Isabelle Batthyány: So we generate photo realistic avatars, even voice clear on them and can let them talk in every language.
• 14:11
  Marie-Isabelle Batthyány: So the avatar takes over the explanation part in a very.
• 14:16
  Marie-Isabelle Batthyány: Personal audiovisual way, and this is especially interesting for surgeons who don't see their patients much or not at all.
• 14:25
  Marie-Isabelle Batthyány: Um, and it creates kind of a cool link between patient and surgeon where they explain personally, uh, how they perform, uh, in their or, and it simply bows the patient, what their doc can do.
• 14:41
  Joseph M. Schwab: Wow.
• 14:41
  Joseph M. Schwab: So there's a lot to unpack there.
• 14:44
  Joseph M. Schwab: And the question, the first question I really have about this is you described a number of things that to me sound very technical.
• 14:53
  Joseph M. Schwab: Challenging to have built, and I'm interested to know from your perspective, which part was the most technically challenging and, and, and why.
• 15:02
  Joseph M. Schwab: Mm-hmm.
• 15:05
  Marie-Isabelle Batthyány: Well, we, we spent a great deal on the eye tracking algorithm.
• 15:09
  Marie-Isabelle Batthyány: I think that was the most challenging part.
• 15:12
  Marie-Isabelle Batthyány: Uh, on one hand you have, uh, you depend on, on hardware development, where does it stand?
• 15:18
  Marie-Isabelle Batthyány: And when we started in 2020, uh, VR hardware available wasn't as good as it is today.
• 15:25
  Marie-Isabelle Batthyány: So we had to ask our ques, the question was, uh, how do we measure attention so we can use it to verify user engagement and thus provide a solid base for higher legal safety in information transfer in general.
• 15:41
  Marie-Isabelle Batthyány: Um, and evidence from feasibility studies out of the gaming sector helped us a lot in product development.
• 15:47
  Marie-Isabelle Batthyány: So after all, we want our patients to focus on important parts of the videos we create and watch.
• 15:54
  Marie-Isabelle Batthyány: So where do we place things?
• 15:57
  Marie-Isabelle Batthyány: How do we place them in the videos so we can align it with the tracking algorithm that actually makes sense.
• 16:03
  Marie-Isabelle Batthyány: So, so we first looked into video content generation.
• 16:08
  Marie-Isabelle Batthyány: And, uh, back then I, in the beginnings, I took part in a German study, which later became one of the most European, most cited European guidelines in how to transfer health information to, to the general population and the German network of evidence-based medicine published that very successfully.
• 16:29
  Marie-Isabelle Batthyány: Uh, it was very good to see that something was happening on the informed consent sector.
• 16:34
  Marie-Isabelle Batthyány: So the two major challenges were eye tracking and a usable, useful, understandable algorithm, easy for doctors, as well as judges to interpret.
• 16:45
  Marie-Isabelle Batthyány: And secondly, how to create the technical side of the 3D videos that they are engaging and understandable.
• 16:54
  Marie-Isabelle Batthyány: To the non-gaming population because of course, all big gaming companies have been very successful and, and, uh, in, in Croatian.
• 17:05
  Marie-Isabelle Batthyány: But, uh, when you, when you have to speak to everybody in your clinic, uh, language design, color placement, icons, inserts, everything becomes important.
• 17:22
  Marie-Isabelle Batthyány: And the, the XRS team at that time worked very closely with a highly specialized company, COER from Zurich, Switzerland.
• 17:33
  Marie-Isabelle Batthyány: That's why we have Swiss made software.
• 17:36
  Marie-Isabelle Batthyány: And also my CTO Christophe is employed there, uh, still.
• 17:41
  Marie-Isabelle Batthyány: So he has a double role, uh, which comes in very handy because we have a great, uh, communication between, uh, the, the two manufacturing companies and.
• 17:52
  Marie-Isabelle Batthyány: The guys came up with a patentable idea on their eye tracking, so we were granted the US patent this year for attention tracking in medical education and informed consent, which I'm very proud of.
• 18:06
  Joseph M. Schwab: Um, and your clinical results, at least what I can find online.
• 18:11
  Joseph M. Schwab: Seem pretty impressive.
• 18:13
  Joseph M. Schwab: I've got an 84% recall accuracy and a published 87.5% patient satisfaction.
• 18:21
  Joseph M. Schwab: My question is this, how does that compare to traditional materials?
• 18:26
  Marie-Isabelle Batthyány: Yes.
• 18:27
  Marie-Isabelle Batthyány: Um, orthopedic surgeon, whom many of our listeners know, I'm sure, and Peter Maho, a friend of mine in pediatric anesthesiologist, they, uh, looked into that early on in product development.
• 18:42
  Marie-Isabelle Batthyány: So they compared patient satisfaction with 3D videos and vr, uh, consenting them on, on, uh, actually hip replacement.
• 18:53
  Marie-Isabelle Batthyány: And knee replacement and, uh, general anesthesia.
• 18:57
  Marie-Isabelle Batthyány: So against patients that had to read paper forms and the results were nearly embarrassingly high in favors to vr.
• 19:06
  Marie-Isabelle Batthyány: So, in VR we work with immersion and, uh, Brennan Beagle of the Cina Sinai Hospital.
• 19:13
  Marie-Isabelle Batthyány: He calls VR the Empathy Machine, and being in a nice comfy room, you search and taking the time.
• 19:24
  Marie-Isabelle Batthyány: In that brain trick of course, but to explain everything to you, uh, and you're not distracted.
• 19:30
  Marie-Isabelle Batthyány: It works wonders on concentration and recall.
• 19:34
  Marie-Isabelle Batthyány: Uh, that's why we get so high numbers and uh, it's very convincing numbers too.
• 19:40
  Joseph M. Schwab: I'm interested to know.
• 19:42
  Joseph M. Schwab: So you described what sounds like a very pleasant experience.
• 19:45
  Joseph M. Schwab: Um, is that how I, with the very first early prototypes, is that how it would've looked or did it look different?
• 19:55
  Marie-Isabelle Batthyány: No, that was fun.
• 19:57
  Marie-Isabelle Batthyány: Uh, well, we practically forced our prototype creation on an orthopedic colleague of mine.
• 20:02
  Marie-Isabelle Batthyány: He flew down to Vienna for during the first year of COVID where travel restrictions were heavily in place from the north of Norway out of the snow.
• 20:13
  Marie-Isabelle Batthyány: Uh, and.
• 20:14
  Marie-Isabelle Batthyány: Had to learn the entire tiki a uh, uh, content by heart using pleasant language and appearing nicely and pretty in front of a 360 degree, uh, VR camera.
• 20:28
  Marie-Isabelle Batthyány: Um, we left.
• 20:30
  Marie-Isabelle Batthyány: At that stage at some point.
• 20:32
  Marie-Isabelle Batthyány: But we did prototype and we were able to test, um, in, uh, Viennese also practice, uh, of a very benevolent surgeon who helped us getting started in these early tests.
• 20:44
  Marie-Isabelle Batthyány: So the first prototype really was real VR films, and it just turned out very quickly that that was not a scalable solution at all because we had.
• 20:56
  Marie-Isabelle Batthyány: You made one mistake or had one content adaptation and you had to get the whole filming team together to, um, redo it all again.
• 21:06
  Marie-Isabelle Batthyány: So very quickly switched from prototyping to, um, meta humans from, uh, which were digitally animated avatars, uh, where we could, uh, change content more easily and also adapt, uh, mimic and body language.
• 21:25
  Marie-Isabelle Batthyány: And gender and all this much easier.
• 21:29
  Joseph M. Schwab: So with those initial trials, was there some early feedback or pilot data?
• 21:36
  Joseph M. Schwab: That convinced you after what seemed like maybe a, a little bit of a difficult time getting started, that you were on track towards a solution that might have some real world viability.
• 21:47
  Joseph M. Schwab: Hmm.
• 21:48
  Marie-Isabelle Batthyány: Mm-hmm.
• 21:49
  Marie-Isabelle Batthyány: Patient feedback.
• 21:51
  Marie-Isabelle Batthyány: They found it really cool.
• 21:53
  Marie-Isabelle Batthyány: So a sim, even with the older headsets, we, which we used in the beginning, um, people were just totally bowed by the experience.
• 22:03
  Marie-Isabelle Batthyány: So that feedback was good.
• 22:04
  Marie-Isabelle Batthyány: Our users, the end users, which were not the customers, but the end users liked our solution.
• 22:12
  Marie-Isabelle Batthyány: Uh.
• 22:13
  Marie-Isabelle Batthyány: Very early in the beginning.
• 22:15
  Marie-Isabelle Batthyány: The second part was, uh, that the, the eye tracking development, uh, looked very promising.
• 22:22
  Marie-Isabelle Batthyány: And, um, I think what also showed us, uh, that what also was kind of a different kind of, uh, pilot data was that.
• 22:36
  Marie-Isabelle Batthyány: We have so many, uh, desperate orthopedic surgeon tangled in lawsuits that, uh, really very frequently asked us, how far are you with your product?
• 22:46
  Marie-Isabelle Batthyány: We really need to, uh, to, to explore this and want to be, uh, safer on the legal side than we feel now.
• 22:55
  Marie-Isabelle Batthyány: And another pilot data, which turned out to be.
• 22:59
  Marie-Isabelle Batthyány: Very good for us was that we got, uh, attorney's opinions from various countries attesting that we are among the first solution where the clinicians can outsource repetitive and documentational tasks into tech saving time and expensive doctor's time actually, and, and, and, and really dumb, rather dumb tasks.
• 23:23
  Marie-Isabelle Batthyány: Um, who to.
• 23:27
  Marie-Isabelle Batthyány: Actually, yeah, improve their everyday work life and having this legal backup also propelled the product forward, um, that we're doing something useful for here.
• 23:38
  Joseph M. Schwab: So speaking of multiple countries, you now have, I think, over 4,000 sort of real patient uses across Austria, Switzerland, Poland, and France.
• 23:51
  Joseph M. Schwab: Um, what have those early deployments taught you about product market fit?
• 24:00
  Marie-Isabelle Batthyány: Hmm.
• 24:03
  Marie-Isabelle Batthyány: I think I can answer that with the three T, with the three threes.
• 24:08
  Marie-Isabelle Batthyány: That's difficult for a German speaking person to say that it takes three times longer than you think It costs three times as much, and you have to change your product at least three times all over again.
• 24:25
  Marie-Isabelle Batthyány: Uh.
• 24:26
  Marie-Isabelle Batthyány: It's in fast paced tech, you have to be constantly on the forefront of development.
• 24:33
  Marie-Isabelle Batthyány: Um, you have to redo so many things.
• 24:35
  Marie-Isabelle Batthyány: And my stepfather and mentor, who is a professor in statistics, he always told me that, and he told me that from the beginning.
• 24:42
  Marie-Isabelle Batthyány: And he said, also, you will start with something entirely different than with what you started out.
• 24:50
  Marie-Isabelle Batthyány: And.
• 24:51
  Marie-Isabelle Batthyány: My ideal from, from looking at a product market fit, ideal example actually, was that I'm honest here.
• 25:00
  Marie-Isabelle Batthyány: Um.
• 25:01
  Marie-Isabelle Batthyány: Farmer came as a surprise in early development phase.
• 25:06
  Marie-Isabelle Batthyány: We had just gotten funding and had focused much on informed consent in presurgical consent until Boehringer Ingelheim expressed interest in using it for study participation, informed consent, and the team at BI is very supportive and great to work with and for them.
• 25:25
  Marie-Isabelle Batthyány: It was a very good fit.
• 25:26
  Marie-Isabelle Batthyány: So they wanted a solution that actually supports the study center staff to increase recruitment success, um, and to, to, uh, support study adherence, give caregiver involvement, and produce dropout rates so participants can now revisit content they might have forgotten in the meantime, and find comfort and better recall of what's going to happen during a treatment cycle.
• 25:52
  Marie-Isabelle Batthyány: So.
• 25:53
  Marie-Isabelle Batthyány: That I think was the nicest for me, the nicest product market fit example, and it taught me many things.
• 26:03
  Joseph M. Schwab: So let's talk a little bit about your business strategy, because you've been, I would say, fairly intentional that XRS Medical is a company designed.
• 26:15
  Joseph M. Schwab: With acquisition in mind, um, what does that change about how you make company decisions?
• 26:26
  Marie-Isabelle Batthyány: I never wanted to build a family business.
• 26:29
  Marie-Isabelle Batthyány: I think it, it's a good, good thing to be clear about this beforehand, before you get started.
• 26:36
  Marie-Isabelle Batthyány: And my three daughters will take off into the world soon.
• 26:40
  Marie-Isabelle Batthyány: And although they're very interested in what I do, uh, they have different things on their mind.
• 26:45
  Marie-Isabelle Batthyány: So it was very clear from the beginning.
• 26:48
  Marie-Isabelle Batthyány: Um, I will.
• 26:50
  Marie-Isabelle Batthyány: I have to do something very different to many startups because I was already 42 when I started the company and um, I'm very much an anesthesiologist, so I certainly had very stubborn ideas on how I would.
• 27:06
  Marie-Isabelle Batthyány: Like to do things and I decided, uh, on the decision making part, uh, not to build a huge team right at the start, but trying to keep the company agile and fast.
• 27:19
  Marie-Isabelle Batthyány: Pretty much what I was used to and am I am still active practicing anesthesia.
• 27:25
  Marie-Isabelle Batthyány: Um.
• 27:27
  Marie-Isabelle Batthyány: That you have fast, agile, small teams where you can make quick decisions and you can respond to your customer's need to protection, changes, whatever comes up in a very, very quick way.
• 27:40
  Marie-Isabelle Batthyány: And to be acquire for, for somebody, uh, to, to bring in a huge team.
• 27:48
  Marie-Isabelle Batthyány: Um, if you only might want to have the CEO to build a new team inside their firm.
• 27:56
  Marie-Isabelle Batthyány: Um, I structured XRS, uh, in a way that it's, it's fairly easy to take over and I also never made a secret out of that and, and implemented a Phantom Shares program for employees incorporating funds at a very early stage.
• 28:12
  Marie-Isabelle Batthyány: So an exit is a very great incentive for a hardworking team, and they need to be okay with changing to corporate or to look for new adventures at some point.
• 28:23
  Joseph M. Schwab: Yeah.
• 28:24
  Joseph M. Schwab: And when you're thinking about acquiring partners or partners that could acquire your company, what are you thinking?
• 28:31
  Joseph M. Schwab: Are you thinking a med tech company, a company in digital health, or maybe a large hospital group?
• 28:38
  Joseph M. Schwab: What would be your ideal partner?
• 28:41
  Marie-Isabelle Batthyány: Um, XRS has customers in several segments.
• 28:45
  Marie-Isabelle Batthyány: Um, so I think we're interesting for.
• 28:49
  Marie-Isabelle Batthyány: Various partners.
• 28:50
  Marie-Isabelle Batthyány: Um, the most likely is pharma or large Hollywood Hospital Group.
• 28:55
  Marie-Isabelle Batthyány: I nearly said Hollywood Group.
• 28:58
  Marie-Isabelle Batthyány: Uh, a large hospital group for deployment, scaling within their own sites.
• 29:03
  Marie-Isabelle Batthyány: Um, one thing that, uh, that might be interesting for an acquiring firm is that I was.
• 29:13
  Marie-Isabelle Batthyány: In the beginning, told to, to focus on one stream, on one project, on one thing.
• 29:21
  Marie-Isabelle Batthyány: And I met a down in Harvard, uh, right at the beginning in 2020, just before lockdown.
• 29:28
  Marie-Isabelle Batthyány: And, uh, she's a professor for, for, uh, economics, um, and, and all kinds of other great things in Germany right now.
• 29:38
  Marie-Isabelle Batthyány: And she told me, Marie, you need to think big.
• 29:41
  Marie-Isabelle Batthyány: So we.
• 29:43
  Marie-Isabelle Batthyány: XRS very early on developed three streams.
• 29:47
  Marie-Isabelle Batthyány: We, our customers are, uh, healthcare providers, the pharmaceutical industry as well as medical product manufacturers.
• 29:55
  Marie-Isabelle Batthyány: So an acquirer acquires, um, several revenue streams in different branches and thus reducing risk for whom.
• 30:05
  Marie-Isabelle Batthyány: That is interesting.
• 30:07
  Marie-Isabelle Batthyány: I think we'll see.
• 30:09
  Joseph M. Schwab: From your perspective, what should innovators understand about building something that a larger enterprise one day might want to acquire?
• 30:18
  Joseph M. Schwab: What would, what do you wish you would've known a few years ago?
• 30:29
  Marie-Isabelle Batthyány: I think, uh, um, it's largely underestimated by startups, young startups, uh, the big role.
• 30:40
  Marie-Isabelle Batthyány: Revenues play, revenues and traction, and you actually have to show to a larger enterprise that somebody else besides them is willing to pay for your product.
• 30:55
  Marie-Isabelle Batthyány: Um, so.
• 30:57
  Marie-Isabelle Batthyány: I think this innovators should understand.
• 31:00
  Marie-Isabelle Batthyány: Don't be so much focused on investment or grant financing.
• 31:04
  Marie-Isabelle Batthyány: You always need this in the beginning, but you need to find the, the jumping point where you go from research, from gather data, from from data gathering from.
• 31:17
  Marie-Isabelle Batthyány: To actually into the business world and, and getting your product out into the market.
• 31:22
  Marie-Isabelle Batthyány: And if that's a pilot or prototyping or whatever it is, it's great if somebody gives you a dollar for it.
• 31:30
  Marie-Isabelle Batthyány: Um.
• 31:31
  Marie-Isabelle Batthyány: Uh, you're already showing that somebody's interested.
• 31:34
  Marie-Isabelle Batthyány: That and, um, a clean due diligence.
• 31:39
  Marie-Isabelle Batthyány: This is also something, um, I think it comes with age that one considers structure a big different than somebody in their mid twenties.
• 31:51
  Marie-Isabelle Batthyány: It has a different, um, experience packing the whole thing, so.
• 31:58
  Marie-Isabelle Batthyány: What I see regularly in, in my, in, in, in the startup environment is that the startups don't have their due diligence ready and acquiring firms.
• 32:09
  Marie-Isabelle Batthyány: Uh, they expect them to have it ready.
• 32:13
  Marie-Isabelle Batthyány: So this is a recommendation.
• 32:15
  Marie-Isabelle Batthyány: Do it from the beginning and be thorough about it.
• 32:19
  Joseph M. Schwab: So you brought up funding and I'm curious, since your product crosses virtual reality, artificial intelligence, legal compliance, clinical workflows.
• 32:33
  Joseph M. Schwab: There had to have been some challenging part of fundraising for a product that crosses so many of those, uh, uh, so many of those areas.
• 32:41
  Joseph M. Schwab: What was the most challenging part?
• 32:45
  Marie-Isabelle Batthyány: Uh, I think, uh, the fundraising landscape in Europe is, um, very different to the one in us.
• 32:53
  Marie-Isabelle Batthyány: Uh, there are different attitudes shared, um, but looking at, at it from the European perspective, um, the challenging part is to find a good investor fit.
• 33:08
  Marie-Isabelle Batthyány: I was lucky that I had a family office from the beginning, a Swiss family office investing, uh, in the first round that gave me the ability to, to come from, to pro, proceed from the idea to product.
• 33:22
  Marie-Isabelle Batthyány: But, um, immersive technology was stuck for a long time in the nineties and it kind of didn't evolve much until, um, meta and Google and Samsung started investing.
• 33:37
  Marie-Isabelle Batthyány: So one of the biggest challenges in fundraising was, uh, to raise for, uh, disruptive technology.
• 33:45
  Marie-Isabelle Batthyány: Everybody kind of knew and felt, okay, this is going to be tricky to bring it into hospitals because change management is not something the healthcare sector is famous for.
• 33:57
  Marie-Isabelle Batthyány: Um, so, so convincing investors that, uh, you have a plan.
• 34:05
  Marie-Isabelle Batthyány: And that this disruptive technology is actually necessary as a step from dumb phone to smartphone when I was in my mid twenties.
• 34:15
  Marie-Isabelle Batthyány: Um, that it will come, but it will take patience and a bit of time because we are not quite there yet.
• 34:25
  Marie-Isabelle Batthyány: Yes, I would sum it up as, as that being the trickiest part.
• 34:30
  Joseph M. Schwab: You, so you mentioned some of the difference between the European market and the US market.
• 34:36
  Joseph M. Schwab: How has been a physician led European startup, how has that influenced your strategy both on the the regulatory side and maybe on the commercialization side?
• 34:51
  Marie-Isabelle Batthyány: This is such a great Quest question.
• 34:53
  Marie-Isabelle Batthyány: Really it is, uh, because us, us Europeans physicians, we practically grow up in regulation, that makes thinking in these terms a bit easier.
• 35:07
  Marie-Isabelle Batthyány: I think, um, docs.
• 35:10
  Marie-Isabelle Batthyány: Our great entrepreneurs.
• 35:11
  Marie-Isabelle Batthyány: Why?
• 35:12
  Marie-Isabelle Batthyány: Because we're used to taking risks and we are used to making fast decisions.
• 35:17
  Marie-Isabelle Batthyány: We have great clinical insight from our everyday work, um, and it certainly influences how we approach the regulatory sector.
• 35:28
  Marie-Isabelle Batthyány: We know how to, what to anticipate because we are subjects to regulatory, um, confinement to some extent.
• 35:37
  Marie-Isabelle Batthyány: Let me call it that.
• 35:39
  Marie-Isabelle Batthyány: Of course rules are written necessary, but sometimes really it can be overdone.
• 35:46
  Marie-Isabelle Batthyány: The physician knows.
• 35:51
  Marie-Isabelle Batthyány: Very well, I think what will work in clinical life, so how to build a product that is actually used and to commercialize it further, uh, deploy the network, which in Europe it's, uh, very close network, uh, because.
• 36:10
  Marie-Isabelle Batthyány: Many countries in, um, in a, a certain space, so everybody at some point knows each other.
• 36:17
  Marie-Isabelle Batthyány: And that nece, that network is very necessary, uh, if you want to get started with a, uh, an allegedly complicated MedTech or tech product.
• 36:30
  Marie-Isabelle Batthyány: Um, and, and I think it gives us an advantage when you are a clinician, uh, entrepreneur.
• 36:39
  Joseph M. Schwab: So speaking of your role as a clinician entrepreneur, you've created this core team, uh, which spans anesthesiology, orthopedic surgery, software engineering.
• 36:52
  Joseph M. Schwab: How did you, did you choose your co-founders or did they choose you and what makes your sort of core team function so well?
• 37:04
  Marie-Isabelle Batthyány: Um.
• 37:06
  Marie-Isabelle Batthyány: XRS is software, doctors, content creation, and legal.
• 37:11
  Marie-Isabelle Batthyány: So that's pretty much the core.
• 37:14
  Marie-Isabelle Batthyány: And the team grew actually.
• 37:16
  Marie-Isabelle Batthyány: So we started up out as a group of three.
• 37:20
  Marie-Isabelle Batthyány: Um, some of them dropped out again and new ones came.
• 37:25
  Marie-Isabelle Batthyány: Uh, the content guys prefer not to be in the website.
• 37:28
  Marie-Isabelle Batthyány: They love the screens more than the photo studios, so, uh, they brought in extensive experience on 30 years of filmmaking, first analog, and then VR in the nineties.
• 37:39
  Marie-Isabelle Batthyány: And now they are, those guys are on the latest hot stuff on the market whenever it comes to AI avatars, immersive design, custom products.
• 37:50
  Marie-Isabelle Batthyány: Um.
• 37:51
  Marie-Isabelle Batthyány: The doctors understand clinical life.
• 37:55
  Marie-Isabelle Batthyány: So in the core team, that's Johan and me, um, uh, Johan acting as a medical advisor.
• 38:02
  Marie-Isabelle Batthyány: Uh, but we have an extensive, uh, network around us on medical experts in different fields supporting us.
• 38:11
  Marie-Isabelle Batthyány: Uh, the Swiss engineers.
• 38:15
  Marie-Isabelle Batthyány: We picked them because they were, uh, uniquely qualified to combine medical software and immersive tech, which is a very rare combination.
• 38:24
  Marie-Isabelle Batthyány: And they are also very active in surgical navigation for big, um, big, uh, medical product manufacturers.
• 38:33
  Marie-Isabelle Batthyány: Uh, so this combination.
• 38:37
  Marie-Isabelle Batthyány: And being able to talk to each other on a very professional level.
• 38:41
  Marie-Isabelle Batthyány: We are about all the same age, and each of us brings in a lot of life experience and also, um, some entrepreneurial background.
• 38:53
  Marie-Isabelle Batthyány: That made, I think that the team growth and the productivity very unique and very beneficial to, to both of us.
• 39:01
  Marie-Isabelle Batthyány: So the doctors advise both arms of XRS on, on the clinical feasibility and software, as well as the patient usability and video design.
• 39:12
  Marie-Isabelle Batthyány: And of course, legal takes care of all of us.
• 39:18
  Joseph M. Schwab: And so you're, you function, I mean, you're the clinician founder.
• 39:23
  Joseph M. Schwab: Is there something you've learned about leading an an innovation focused company that you didn't learn in medical school?
• 39:34
  Marie-Isabelle Batthyány: Yeah, everything concerning business.
• 39:39
  Marie-Isabelle Batthyány: I think it really is.
• 39:41
  Marie-Isabelle Batthyány: Uh, I think.
• 39:43
  Marie-Isabelle Batthyány: Again, this, this is very different to US clinicians, but in Europe, uh, educating physicians and surgeons in economics is just not done from the healthcare provider standpoint.
• 39:54
  Marie-Isabelle Batthyány: That's understandable.
• 39:56
  Marie-Isabelle Batthyány: They want doctors to to, to be in the system, to stay in the system and keep it up and running and not go out there and innovate things.
• 40:04
  Marie-Isabelle Batthyány: So I, um.
• 40:07
  Marie-Isabelle Batthyány: I didn't think much about the, the toughness of being an entrepreneur and I had to learn the business language because I only knew the medical language and I didn't know anything about accounting.
• 40:20
  Marie-Isabelle Batthyány: Oh God, it's still my nemesis.
• 40:24
  Marie-Isabelle Batthyány: Um, so it's all these business aspects which we are not taught.
• 40:29
  Marie-Isabelle Batthyány: The MBA did help.
• 40:32
  Marie-Isabelle Batthyány: To some extent, uh, but does it really make a difference in the real world for a 40-year-old doctor?
• 40:41
  Marie-Isabelle Batthyány: I am not so sure you really, I had to go out there and learn the hard way.
• 40:47
  Marie-Isabelle Batthyány: Um, I didn't know much about financial structures, term sheets, um, marketing strategies, all this.
• 40:55
  Marie-Isabelle Batthyány: Uh, I spoke to a lot of people, so if you ask me what I have learned every day.
• 41:02
  Marie-Isabelle Batthyány: Sorry to have extended that answer.
• 41:05
  Marie-Isabelle Batthyány: Uh, but you really, everything, literally everything I had to earn from scratch.
• 41:11
  Joseph M. Schwab: You mentioned your MBA, which you actually got during COVID, if I'm not mistaken, during the, starting in the spring of 2020.
• 41:19
  Joseph M. Schwab: Was there anything about that experience?
• 41:22
  Joseph M. Schwab: I, I recognize that you just sort of answered that you have learned a lot sort of on the job.
• 41:28
  Joseph M. Schwab: Is there anything about that experience of getting your MBA during such a unique time that influenced your thinking or ultimately helped shape the idea of how you wanted to found XRS medical?
• 41:45
  Marie-Isabelle Batthyány: Yeah, I think yes, of course it did, because it was the time where, where the, the idea came up.
• 41:53
  Marie-Isabelle Batthyány: It was, um, it's always about people.
• 41:56
  Marie-Isabelle Batthyány: It's always the people.
• 41:58
  Marie-Isabelle Batthyány: And an MBA tends to bring people together, value lies in conversation and networking and.
• 42:04
  Marie-Isabelle Batthyány: Training ideas in a structured way.
• 42:07
  Marie-Isabelle Batthyány: So again, does it prepare you for out there?
• 42:10
  Marie-Isabelle Batthyány: I think it's maybe not so much, but was it in the best case, it pushes you out of your comfort zone.
• 42:21
  Marie-Isabelle Batthyány: And I think that's what it did.
• 42:23
  Marie-Isabelle Batthyány: You got together with other people, they told you things, you pondered that in your mind, and then you said, okay, uh, I'm doing only anesthesia.
• 42:32
  Marie-Isabelle Batthyány: I don't mean it in a demeaning way, but after some time you do, uh, it, it, a change can be valuable.
• 42:40
  Marie-Isabelle Batthyány: So I remained in anesthesia, but added to that, um.
• 42:46
  Marie-Isabelle Batthyány: Talking and getting fresh ideas, uh, really did push me out of the comfort zone, and I just went out and founded this company and it's been a wild ride since then.
• 42:58
  Joseph M. Schwab: Is there a particularly personal, a personally meaningful moment that you've experienced on this journey so far?
• 43:10
  Marie-Isabelle Batthyány: May I be really honest?
• 43:11
  Joseph M. Schwab: Please.
• 43:13
  Marie-Isabelle Batthyány: Yes.
• 43:14
  Marie-Isabelle Batthyány: When I first got, when I got the first cash to bring the idea to life, that was a moment.
• 43:21
  Marie-Isabelle Batthyány: Really looking back, I'm so in awe that, uh, that this was, this family office gave us the money to go into prototyping with a wild idea.
• 43:32
  Marie-Isabelle Batthyány: Nobody really knew if it would work.
• 43:36
  Marie-Isabelle Batthyány: There was nothing like it on the market you could compare it to.
• 43:39
  Marie-Isabelle Batthyány: So it, it really was a thrill to, to look at your account statement and see, okay, this is what I'm going to do the next years.
• 43:49
  Marie-Isabelle Batthyány: And now when I sit with my investor five years later and, uh, we talk about the beginnings, um.
• 43:58
  Marie-Isabelle Batthyány: We, we tried to laugh about it, but I think we were both very, very afraid that this would go sideways.
• 44:06
  Marie-Isabelle Batthyány: And, uh, they believed in the team they gave us, gave me the money and, um, the thrill of, of, of being able to move something that I think was a very, very meaningful moment.
• 44:20
  Marie-Isabelle Batthyány: Yes.
• 44:21
  Marie-Isabelle Batthyány: Mm.
• 44:22
  Joseph M. Schwab: so you've made it past five years.
• 44:25
  Joseph M. Schwab: Where is XRS medical in five years from now?
• 44:29
  Joseph M. Schwab: Both geographically, let's say clinically and technologically.
• 44:33
  Joseph M. Schwab: Where's it going?
• 44:35
  Marie-Isabelle Batthyány: We have, um.
• 44:39
  Marie-Isabelle Batthyány: Very strong expansion tendencies, meaning that, uh, we want to enter the US market in the beginning of 26.
• 44:48
  Marie-Isabelle Batthyány: There are first negotiations with, uh, key opinion leaders, um, about, uh, getting started.
• 44:55
  Marie-Isabelle Batthyány: So this is exciting.
• 44:57
  Marie-Isabelle Batthyány: Uh, the other markets include Japan because I have a very good network, uh, into Japan and also.
• 45:07
  Marie-Isabelle Batthyány: Uh, there are tech affinity, uh, for vr.
• 45:10
  Marie-Isabelle Batthyány: Um, among the population is very high.
• 45:13
  Marie-Isabelle Batthyány: So, uh, the next steps are the US and Japan.
• 45:18
  Marie-Isabelle Batthyány: But in the end, in five years, um, we would like to expand worldwide, uh, which is most likely within the pharmaceutical sector.
• 45:28
  Marie-Isabelle Batthyány: Um.
• 45:29
  Marie-Isabelle Batthyány: And technologically, I would really love to see avatars answering patient's questions in VR in real time, out of, um, uh, well-trained AI database.
• 45:44
  Marie-Isabelle Batthyány: Um.
• 45:46
  Marie-Isabelle Batthyány: And, and enabling hands-free communication, voice controlled.
• 45:50
  Marie-Isabelle Batthyány: I think it will make our lives, mostly our necks better not to stare at our phones all the time, but actually look into the other one's face, even if you're wearing a device.
• 46:02
  Marie-Isabelle Batthyány: But anything's better than this.
• 46:05
  Joseph M. Schwab: Hopefully you're not going to design it, so the avatars do the surgery too.
• 46:09
  Joseph M. Schwab: We still like doing the surgery.
• 46:11
  Joseph M. Schwab: Okay.
• 46:12
  Marie-Isabelle Batthyány: Yes, and I like the orthopedic surgeons also very much.
• 46:17
  Marie-Isabelle Batthyány: They are my very esteemed colleagues at the hospital, and I want them in person there too.
• 46:23
  Marie-Isabelle Batthyány: I totally agree with you.
• 46:26
  Joseph M. Schwab: So if you could look at a group of future founders, um, who hope to turn an idea into a real scalable solution similar to what you're doing with XRS medical, what advice would you give to them?
• 46:41
  Marie-Isabelle Batthyány: I may answer this in, uh, bullet points, uh, because it's pretty straightforward.
• 46:49
  Marie-Isabelle Batthyány: Leadership needs to be clear from the beginning.
• 46:52
  Marie-Isabelle Batthyány: Who is the boss?
• 46:53
  Marie-Isabelle Batthyány: Um.
• 46:54
  Marie-Isabelle Batthyány: Hire only when you really, really, really, really need it.
• 47:00
  Marie-Isabelle Batthyány: Check your, if you have buyers as early as possible to build a feasible market fit.
• 47:06
  Marie-Isabelle Batthyány: And on the danger of repeating myself, um, have a good quality and risk management from the beginning, uh, to, to not be surprised when somebody actually walks up to you and says, Hey, I would like to buy you.
• 47:23
  Joseph M. Schwab: Um, so this series is called From Idea to Market.
• 47:29
  Joseph M. Schwab: And if you could just give me in, in one sentence, what does that phrase mean to you with the journey you've been on, um, at, at this stage?
• 47:40
  Marie-Isabelle Batthyány: I will use, uh, full words, uh, five words as a one sentence, blood, sweat, tears, highs and lows.
• 47:48
  Marie-Isabelle Batthyány: One can also say, uh, from idea to market means, um, leading with clarity and actually purpose, it makes you stick to things and turning a real need, not an imagined need, but a real need into a validated from the beginning, clinically validated solutions, building with users not.
• 48:16
  Marie-Isabelle Batthyány: Not for them and driving it forward until it creates really an impact in the real world.